Why Are So Many Black Women Dying of AIDS? The New York Times
By Laurie Shrage
December 11, 2015

The injustices caused by racial profiling in law enforcement, and bias in criminal prosecution and sentencing, are now a subject of significant public attention. And they should be. The loss of life and liberty from these practices is shameful and tragic. But it is critical that we do not overlook the significant evidence showing that the end result of these practices — the mass incarceration of nonwhite men — may also be fueling an urgent public health crisis among some of the most disadvantaged members of our society.

Although African-Americans represent about 12 percent of the United States’ population, they account for roughly half of all new infections and deaths from H.I.V./AIDS. The H.I.V. infection rate among black women is 20 times higher than for white women, and in 2004, H.I.V./AIDS was the leading cause of death for black women ages 25-34. During a 2007 Democratic primary debate, Hillary Clinton called attention to this statistic and asserted: “If H.I.V./AIDS were the leading cause of death of white women between the ages of 25 and 34, there would be an outraged outcry in this country.”

Given that men who have sex with men account for a majority of H.I.V. cases among both black and white men, the spike in H.I.V. infections among black women has perplexed public health officials. Because most gay men do not have female sexual partners and there are relatively low rates of infection among nonblack women, and because rates of injection drug use or unprotected sex among black women are no higher than for other groups, the rapid increase in H.I.V./AIDS cases among black women has been hard to account for. But several public health studies now suggest that because people tend to select sex partners from within their own communities, higher rates of H.I.V. among men who have been in prison may raise the risk of infection in their community.

A study conducted by two professors of public policy at the University of California, Berkeley, determined that from 1970 to 2000, a period in which the incarceration rates for black men skyrocketed to roughly six times the rate for non-Hispanic white men, the H.I.V./AIDS infection rate for black women rose to 19 times the rate for non-Hispanic white women. Using various sources of data to investigate the connection between these developments, they concluded that “higher incarceration rates among black males explain the lion’s share of the black-white disparity in AIDS infection rates among both men and women.”

The exact transmission rates for prisoners are not known, and the Centers for Disease Control and Prevention reports that the majority of prisoners with H.I.V. are exposed to the virus before they are incarcerated. Yet some researchers have concluded that incarceration is a risk factor for H.I.V. infection for the following reasons: There is a higher prevalence of H.I.V. among prison populations; there are higher than average rates of sexual assault and coercive sex among men in prison; inmates have little access to condoms; injectable drugs and tattooing are risk factors that also occur in prisons; and when people are released from prison they typically have inadequate access to health care and treatment because of unemployment and poverty. In addition, high incarceration rates substantially reduce the number of men in black communities and rupture social relationships, which may increase the number of concurrent sexual partners each man has.

These facts suggest that an important contributor to the H.I.V. crisis among black women may be hyper-incarceration. Importantly, these studies help dispel the sorts of stereotypes that have hobbled responses to this H.I.V. crisis. “Secretive” or “closeted” bisexuals have often been blamed for the spread of H.I.V. to heterosexual black women, but there is little evidence to support the belief that there are higher rates of bisexuality among black Americans who are not in prison. Nor does the explanation lie in riskier health habits. Outside of prison, African-Americans have the same (or lower) rates of risky sex or drug use as other Americans. Explanations like these reinforce homophobic and racist “blame the victim” attitudes. They have also impeded disease reduction by wrongly identifying vectors of transmission.

Once a virus spreads in a particular community, members of that community can be at increased risk for infection, even when their rates of participation in activities that can expose them to the virus are the same as in other communities. Mass incarceration may help explain the spread of H.I.V. to and within the African-American community, including among heterosexual African-American women.

There is an urgent need for new policy approaches. We should demand rigorous enforcement of the standards mandated by the 2003 Prison Rape Elimination Act in order to significantly reduce sexual assaults and coercive sexual practices inside our prisons. We also need to insist that condoms be distributed inside all prisons, and that incarcerated individuals have access to H.I.V. testing and treatment before and after their release. Finally, we must continue to work to eliminate racial profiling in our criminal justice system, and significantly reduce incarceration rates by revising laws and punishment practices that unnecessarily send so many nonviolent lawbreakers to prison.

With a better understanding of the compounded injustices that may contribute to the spike in H.I.V./AIDS rates among African-Americans, let’s hope there will soon be an “outraged outcry” about the unnecessary loss of black lives from both H.I.V./AIDS and mass incarceration.